An Audit of the Management of Shoulder Dislocations

Graeme Wilson, Jochen Fischer

Background: Shoulder dislocations are a common presentation to Accident & Emergency Departments and their management after initial reduction is important for long term morbidity. There are guidelines published by the British Elbow & Shoulder Society (BESS) regarding the management of these injuries. All patients under 25 years should have early specialist decision making, patients between 25-40 years should be reassessed at the 3-6 month mark and scanned if symptomatic, and patients over 40 years should have early diagnostic imaging and early rotator cuff repair.

Aim: To audit management of first time shoulder dislocations against BESS Guidelines.

Method: This was a retrospective audit of adults presenting to Macclesfield DGH with a first time dislocation between August 2016 – July 2017 who were followed up at Macclesfield DGH (n=24). Patients were identified using clinical coding and all imaging was reviewed to confirm the diagnosis. Clinic letters and investigations were subsequently reviewed. The management was then audited against the BESS guidelines depending on the patients’ age group: <25 (n=1), 25-40 (n=3), and >40 (n=20). ‘Early’ was classified as 6 weeks or less and this was decided locally.

Results: In the <25 group, 0% compliance with guidelines. In the 25-40 age group, 67% compliance with guidelines. In the >40 age group, 0% compliance with guidelines, however 40% of these patients had early imaging, and overall 60% of patients had imaging. 83% of patients scanned had a rotator cuff tear, and the remaining 17% had labral tears. All patients who went on to rotator cuff repair (n=3) were delayed in time to theatre.

Recommendations: Virtual Fracture Clinics to streamline patients into specialist shoulder clinics, investigation of all >40s with Ultrasound scan, and patients requiring rotator cuff repair should be managed on the trauma list and not elective lists.